The Brilliant Village Doctor

Opportunities are always reserved for those who are thoughtful, such as Zhu Zeming.

At the beginning, Lin Hao was not very pleased with him. This guy was not only younger than him, but also more handsome than him. What really upset him was that Ren Junqi seemed to have a special interest in such a small fresh meat, so he took him with him wherever he went.

Therefore, after seeing Lin Hao throw the pipe to the ground, he was more excited than anyone else. His words were a bit incoherent! Obviously, he wanted to make a big deal and brew a medical accident, and then kick Lin Hao out of the hospital, so that he would not get in the way of his eyes, nose and feet.

See next to the nurse Peng Xiaojie just look at him, still don't go out to call the family, also don't call the police, immediately drink: "what do you do? Don't you hurry? "

Peng Xiaojie did not dare to go crazy with him. She hesitated to look at Ren Junqi and obviously asked her what to do?

Although Ren Junqi has the heart to protect Lin Hao, but this guy is really too messy. She doesn't know what it is, so she is in a dilemma. She can only ignore these and go to check the patient!

"Idiot!" Looking at Zhu Zeming who was shouting, Lin Hao scolded him. Then, without looking at him again, he took another piece of new tube and put it back into the patient's endotracheal tube!

It's not so strange!

After a section of the tube was replaced and inserted back, the patient's condition not only recovered rapidly, but also the blood oxygen concentration was only 60%, which suddenly soared to 98%!

Seeing this scene, Ren Junqi was stunned.

Zhu Zeming, who was just opening the door and was going to call up his family members in person, stayed there.

Half ring, he just puzzled ask a way: "this, what circumstance?"

Lin Hao said indifferently, "I'm just a doctor for further study, but I'm not your teacher. What's the obligation to teach you?"

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when Ren Junming cut the tube by mistake, he didn't want to correct the patient.

Seeing that Zhu Zeming couldn't feel his head, she pointed to him and said, "Dr. Zhu, the reason why the patient's blood oxygen concentration can't go up is because the tube you installed is too thin. Lin Hao replaced it with a thicker one! When the tube is big, the breathing is natural and early, and the blood oxygen concentration rises

Zhu Zeming suddenly realized that he had been hit in the face.

Ren Junqi saw this and did not reprimand him. He just said slowly: "when working, it's better to be careful."

"I see!" Zhu Zeming answered, but he looked at Lin Hao, full of bitterness.

After seeing the patient with chest trauma, Ren Junqi was not so relieved and asked Zhu Zeming to take her to see other patients.

All the way to see the past, there is no problem!

Although Zhu Zeming is young, and his education is not as high as Ren Junqi, he has been in the emergency department for more than two years, and his general minor diseases and pains can be handled properly.

Walking and watching, I arrived at the last patient's bed. This is a male patient with upper abdominal pain for four hours. He is 65 years old. He has moderate pain on the navel, without radiation and metastasis. However, he has fever of 38.5 degrees, vomiting and diarrhea. His previous medical history is not special. His chief complaint is that he ate barbecued oysters for supper last night.

After the patient arrived, Zhu Zeming had an examination. The palpation of the upper abdominal muscles was tense. The Mofei sign was negative. There was no obvious tenderness or rebound pain at the appendix point. There was no abnormality in the emergency abdominal plain film and B-ultrasound. He considered for acute gastroenteritis or allergy, given pain relief, anti-inflammatory, anti allergy treatment!

But now it has been two hours, the patient's condition has not improved, still said that the abdominal pain is serious.

After hearing the chief complaint, Zhu Zeming said to the nurse, "give him another injection of 654-2!"

654-2 is an anticholinergic drug, similar to atropine, used for colic caused by spasm of gastrointestinal tract, bile duct, pancreatic duct and ureter. At the same time, it can also be used for circulatory disorders caused by vasospasm and embolism, such as cerebral infarction, insufficient blood supply of cone artery, thromboangiitis obliterans and septic shock.

After giving the doctor's order, he saw Lin Hao touching the patient's pulse, and he looked like an old God. What made him laugh and cry was that while he was probing the patient's pulse, he even touched the patient's abdomen with the other hand. This examination method was undoubtedly funny and did not conform to the inspection rules. He was very disdainful. What could you touch Come on?

After a while, the nurse brought the medicine and was ready to inject the patient.

Who knows Lin Hao saw the situation but stopped: "don't fight, he is not in the right situation!"

Zhu Zeming immediately approached him and asked in a cold voice, "why don't you talk about it?"

Lin Hao said: "although he said that he ate oysters, he also had vomiting and diarrhea. It seems that he is allergic to seafood or acute gastroenteritis, but I don't think so!"

"No?" Zhu Zeming was not angry: "what do you say?"Lin Hao looks dignified way: "my diagnosis is acute appendicitis, and the situation is more serious, must immediately surgery!"

"Acute appendicitis? That's funny enough Zhu Zeming sneered and asked, "have you ever studied medicine? Do you know what acute appendicitis is? Do you understand the diagnostic basis of acute appendicitis? "

Acute appendicitis is one of the most common diseases in abdominal surgery. Most patients can seek medical treatment in time and obtain good therapeutic effect. However, sometimes the diagnosis is quite difficult. If it is not handled properly, serious complications will occur. So far, the mortality of acute appendicitis is still 0.1 ~ 0.5%.

It is estimated that one out of every 1000 people will suffer from acute appendicitis every year. According to general general hospital statistics, the number of acute appendicitis patients in any hospital accounts for about 15% of the total number of inpatients in abdominal surgery in the same period, which is the first in surgical acute abdomen.

Ren Junqi knew that appendicitis is a kind of disease that can be large or small, so when he heard Lin Hao say so, he became cautious and went up to examine the patient.

The diagnosis basis of acute appendicitis is very obvious: first, metastatic right lower abdominal pain. 2、 Right lower abdomen tenderness, rebound pain, muscle tension.

However, after Ren Junqi gave the patient a physical examination, he found that his whole abdomen was painful, but the symptoms of local right lower abdominal pain were not obvious. For a while, he looked at Lin Hao with some doubts. Obviously, he asked him what the basis of such a diagnosis was?

Seeing Lin Hao's silence, Zhu Zeming asked, "what's the matter? Dumb? Talking? "

Ren Junqi thought that Lin Hao really did not know, so he said: "generally, acute appendicitis has obvious tenderness and rebound pain on the patient's MacPherson's point. Even if there is no acute appendicitis, there will be progressive pain in the right lower abdomen, accompanied by nausea and vomiting, increased white blood cells in the blood, and elevated neutrophils."

Can acute appendicitis be ruled out

This, Ren Junqi was asked, she said that although these are the basis for the diagnosis of acute appendicitis, but it is not absolute.

In a typical patient with acute appendicitis, abdominal pain begins with the upper abdomen, xiphoid process, or around the navel. After about six to eight hours or more than ten hours, the abdominal pain gradually moves downward, and finally it is fixed in the right lower abdomen. After the abdominal pain is fixed, the original site of pain can be significantly reduced or even disappeared. The change of abdominal pain is the metastatic right lower abdominal pain, which is also the basis for differential diagnosis from other acute abdomen diseases. About 80% of patients have this feature.

However, this is only a typical patient. The initial pain of atypical patients may be the upper abdomen, the whole abdomen, or even the waist and perineum. Therefore, even if there is no metastatic abdominal pain, it is not easy to completely exclude the existence of acute appendicitis.

Zhu Zeming didn't expect that Lin Hao would still be confused when he arrived at this time. He pointed to Ren Junqi and said, "director, don't listen to his nonsense here. This patient is obviously acute gastroenteritis. Which doctor will come to see him, but he will say that it's acute appendicitis. It's just a mess!"

Lin Hao shook his head. "I didn't mess around. He was really acute appendicitis. For his safety, I suggest..."

"What do you suggest? What do you suggest? You are a doctor of advanced studies. What qualifications do you have to suggest? " Zhu Zeming was so excited that he burst into a rage on the spot. Finally, he even pointed to Lin Hao and said, "this is my patient. Don't tell me what to do here. Get out of here quickly!"

Lin Hao didn't rush with him, but said mildly: "Dr. Zhu, I know that the indication of his acute appendicitis is not very obvious, but my diagnosis is not wrong. He is not only acute appendicitis, but also likely to be perforated immediately. If you don't send him to the general surgery department and let him have the operation, the consequences will be unimaginable! "

"Are you still alarmist here?" Zhu Zeming was even more furious. He raised the hand of the bus and said, "if you don't get out of here, do you believe I'll smoke you?"

Lin Hao stepped back slightly, because he didn't want to fight with him, but he didn't go away. He firmly believed in his diagnosis, but he couldn't explain it.

When the emperor's Sutra has reached the fourth level, its function is incomparably powerful. It can integrate a trace of breath into the pulse, so that his sense of touch is more sensitive and his diagnosis is more accurate. Just now, when he was on the pulse, he felt that the patient was not as simple as ordinary gastroenteritis, so he put his hand on his abdomen for examination. When he touched the appendix, he felt that the Qi and blood there was obviously severe stagnation. Combined with the patient's nausea, vomiting, fever and other symptoms, he was diagnosed as acute appendicitis, which was a very serious kind.

Severe acute appendicitis, is very easy to occur perforation, once perforation that will be life-threatening. If the treatment is not proper, the patient may die in the emergency department. Therefore, he did not leave in anger. Instead, he said to Ren Junqi: "Ren Junqi, you'd better listen to me. Let him transfer to general surgery for surgery, otherwise there will be problems!"

Ren Junqi didn't want to listen to Lin Hao because she was the teacher. Lin Hao should listen to her. But these days of contact, she has known that her ability is not as good as him, is not qualified to be his teacher, on the contrary, he taught himself a lot of valuable knowledge. But even so, it does not mean that she will blindly obey him, this patient seems to have no indication of acute appendicitis!When she hesitated to call the general surgery department, because of the pain, the patient who had been rolling on the bed suddenly quieted down. Then she opened her mouth and said, "doctor, don't make any noise. I don't seem to have any pain anymore."

Zhu Zeming asked suspiciously: "no pain?"

The patient said, "yes, it has been alleviated since you started to make a noise just now. Now it doesn't hurt at all."

Zhu Zeming immediately became proud and pointed to Lin Hao and said, "see, my treatment works. My diagnosis is accurate. He is just an ordinary acute gastroenteritis! What are you telling me about acute appendicitis and perforation? I am a high-quality graduate of Yangcheng Medical University. I need a doctor who has only a secondary school degree to teach me how to do things and how to diagnose? What a shame

Lin Hao said, "I..."

"You what you?" Zhu Zeming ordered him and said, "you'd better leave you, you'd better get out of here, and get out of my mind as far as I can go!" #####